AGREE II Instrument

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AGREE-REX Instructions

The AGREE-REX is intended for application to practice guidelines (PGs). PGs provide recommendations for improving clinical care provided to patients in a variety of settings.

The AGREE-REX can be used by:

  • Guideline developers
    • To evaluate existing guidelines to determine which are of adequate quality and appropriate for application or adaptation to their own context
    • To provide a methodological blueprint for de novo development that will yield high quality recommendations
  • Policy makers and program managers
    • To evaluate the quality of the PG and its recommendations that is being considered for use
    • To help them decide if guideline recommendations are appropriate to inform clinical practice strategies and policy design
  • Health care providers
    • To ensure guidelines recommendations are appropriate for adoption in their clinical setting by completing their own evaluation of the document
  • Researchers
    • To assess the quality of guideline recommendations in a particular topic area
  • Guideline database administrators
    • To assess the quality of guideline recommendations before inclusion in their database
  • Educators
    • To teach critical appraisal skills and core competencies in guideline recommendation development and reporting
  • Stakeholders
    • Interested in supporting the improvement of practice guideline recommendation development, reporting and evaluation

The AGREE-REX is comprised of 9 items representing key PG quality domains:

  1. Clinical Applicability
  2. Values and Preferences
  3. Implementability

Each item contains:

  • Definition of the item
  • Quality criteria for the item
  • Assessment question for quality (7-point response scale, 1=strongly disagree; 7 = strongly agree)
  • Assessment question for suitability for use (7-point response scale, 1=strongly disagree; 7 = strongly agree)

The AGREE-REX also has two overall assessment questions to consider when making an overall judgement about the PG. Both of these assessment questions are rated as ‘yes’, ‘yes with modifications’, or ‘no’.

Appraisal Process:

  • It is recommended that at five appraisers review each PG to increase the reliability of the assessment is a consensus process is not used for scoring.
  • Before applying the tool, users should read the PG in full, as well as any accompanying documents.
  • 2 scoring methods
    • Method 1: Using individual appraisers’ scores
    • Method 2: Reaching consensus
  • Purpose of scoring:
    • To identify limitations of the PG being considered
    • To select high quality PG to implement
    • To select PGs suitable for use in one’s context
  • Interpreting scores:
    • The manual does not weigh final item scores, nor does it define a threshold overall score to differentiate between high, moderate and low quality PG, as there is no empirical basis to define thresholds; however, examples of how the scores can be interpreted are described

Additional information can be found in the AGREE-REX tool, download it here.

If you have additional questions about the AGREE-REX, please contact us.